Thyroxine and thyroid stimulating hormone levels in under-five severe malnourished children
AbstractBackground In Indonesia, protein energy malnutrition (PEM) in
children is still a health problem. Malnourished children will have
growth and development disruption, which is not only caused by
nutritional factor, but might be associated with endocrine system,
such as thyroid hormone metabolism. Hypothyroidism or thyroid
hypofunction could be happened in malnourished children.
Objective The purpose of this study was to assess thyroxine (T4)
and thyroid stimulating hormone (TSH) levels in under-five severe
Methods This was a descriptive study with cross sectional design.
Subjects were all under-five severe malnourished children
based on nutritional evaluation in August 2001 done by local health
care workers in Andir District, Bandung. Severe malnutrition was
defined as weight for age less than -3SD (W/A <-3SD).
Results There were 42 subjects who fulfilled inclusion criteria, aged
11-57 months, five of them showed clinical manifestation of marasmus.
The T4 levels of the 41 subjects were still in normal limits
and within the range of 4.5-11.2 mg/dl. Thirty-nine subjects had
normal TSH levels, ranged from 0.9 to 5.0 mlU/ml, and 2 subjects
showed increased TSH levels of 6.8 and 7.6 mlU/ml, respectively.
Reduced T4 and TSH levels of 3.93 mg/dl and 0.2 mlU/ml, respectively
were detected in one subject
Conclusion In general, the T4 & TSH levels were still normal,
with only one subject (2%) showed low levels of T4 & TSH.
Kliegman RM, Jenson HB, eds. Nelson textbook of pediatrics.
16th ed. Philadelphiaâ€ WB Saunders Company;
2000. p. 169-72.
2. Onis M, Monteiro C, Akre J, Clugston G. The worldwide
magnitude of protein-energy malnutrition: an
overview from the WHO global database on child
growth. Bull WHO 1993;71:703-12.
3. Kurniawan A, Latief D. Childhood malnutrition in Indonesia:
its current situation. Proceedings of the Joint Symposium
on Childhood Malnutrition: Its Consequences and
Management, Department of Nutrition, Department of
Pediatrics, Faculty of Medicine, Sebelas Maret University
and The Center for Human Nutrition, University of
Sheffield, UK; 2001 Feb 19 2001; Surakarta, Indonesia
4. Brown PI, Brasel JA. Endocrine changes in the malnourished
child. In: Suskind RM, Suskind LL, editors.
Textbook of pediatrics nutrition. New York: Raven
Press; 1990. p. 213-28.
5. Waterlow JC. Endocrine changes in severe PEM. In:
protein-energy malnutrition. London; Edward Arnold;
1992. p. 112-25.
6. Ingenbleek Y, Malvaux P. Peripheral turnover of thyroxine
and related parameters in infant protein-calorie
malnutrition. Am J Clin Nutr 1980;3:609
7. Parra A, Klish W, Cuellar A, Serrano PA, Garcia G,
Argote RM, et al. Energy metabolism and hormonal
profile in children with edematous protein-calorie malnutrition.
J Pediatr 1975; 87:307-14.
8. Pirmstone B, Becker D, Hendricks S. TSH Response
to synthetic thyrotropin-releasing hormone in human
protein-calorie malnutrition. J Clin Endocrinol Metab
9. Gorstein J, Sullivan K, Yip R, de Onis M, Trowbridge
F, Fajans P, et al. Issues in the assesment of nutritional
status using anthropometry. Bull WHO
10. Surbakti S. Metodologi pemilihan sampel pada
pengumpulan data antropometri di Indonesia. In: Gizi
Indonesia 1990. p. 79-84.
11. Tenore A, Vargas A. Endocrine changes in malnutrition.
In: Suskind RM, Suskind LL, editors. Textbook
of pediatric nutrition. 2nd ed. New York: Raven Press;
1993. p. 161-71.
12. Hansen JDL, Pettifor JM. Protein energy malnutrition
(PEM). In: McLaren DS, Burman D, Belton NR,
Williams AF, editors. Textbook of pediatric nutrition.
3rd ed. Edinburgh: Churchill Livingstone; 1991.
13. Monckeberg F. Protein energy malnutrition: marasmus.
Clin Nutr of Young Child 1985;121-32.
14. Hall R. Thyroid. In: Hall R, Besser M, editors. Fundamentals
of clinical endocrinology. 4th ed.
Edinburgh: Churchill Livingstone; 1989. p. 66-152.
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